Long-term Physical Disabilities Research Articles

Steps towards eliminating Hansen's disease stigma.

Persons affected by Hansen's disease (PAHD) can develop long-term physical disabilities and psychological problems if the disease is not managed promptly and correctly. The complex and multi-faceted nature of stigma related to Hansen's Disease, and the discrimination arising from it, demands multiple parallel steps to improve the health, well-being and lived experience of People Affected by Hansen's Disease, including: 1) adoption and pursuance of a human rights based approach; 2) revocation of discriminatory laws; 3) education and training for healthcare workers; 4) new techniques and therapies to diagnose and treat HD without side-effects and to reduce risk of disabilities; 5) elimination of stigmatising terminology.

The Prevalence and Causes of Musculoskeletal Pain among Farmers in the Volta Region of Ghana: A Cross Sectional Study

Musculoskeletal pain (MSK) disorder is considered one of the prime causes of severe long-term pain and physical disabilities acquired globally. Ghanaians especially, farmers have to go through vigorous physical farm activities to achieve desired output of farm activities. In the Volta Region, MSK pain has ranked among the top three reported cases at the Ho Teaching Hospital. Whilst, the quantum of reported cases is known, and treated at the hospital, the actual causes are not. Coupled with the fact that prevalence and probably the causes would differ from profession to profession the proposed research is aimed at addressing this among farmers. The overall goal of the study was to determine the prevalence and causes of MSK pain among farmers in the Volta Region of Ghana. 212 farmers were randomly selected for the study. Cross-sectional surveys were carried out to obtain the demographic and socio-economic status of the patients consenting to participate in the studies. Both, qualitative and quantitative statistical methods were employed to determine any association between the farming methods, tools used and the type of MSK pains. The most prevalent locations of MSK pain among farmers were the lower back, upper back, right and left knees. The possible causes of MSK pain reported by farmers in the Volta Region were by walking or by other transportation (riding bicycles and motorbikes) or using implements such as cutlass, hoe and spraying machine. Keywords: Ghana, Farmers, Farming practices, Lower Back Pain, Disability-Adjusted Life Years, Work-related Musculoskeletal Disorder, Musculoskeletal pains.

Identifying built environment factors influencing the community participation of adults aging with long-term physical disabilities: a qualitative study

This study qualitatively explored how adults aging with long-term physical disabilities perceive the built environment to influence their community participation. A convenience sample of community-dwelling adults with long-term physical disabilities ages 45–65 participated in virtual semi-structured interviews until thematic saturation was reached (n = 20). Data were analyzed using interpretive phenomenological analysis. Five themes were identified: vigilance and sense of safety, accessibility of and access to transportation, community environment accessibility, sense of community, and access to support, spaces, and resources during the COVID-19 pandemic. Multiple participants described their neighborhoods as unsafe and reported not leaving their homes in months due to inaccessible home entrances or pandemic-related concerns. These results enhance our understanding of how this population perceives environmental barriers to community participation, particularly in low-resourced neighborhoods during the COVID-19 pandemic. These results may inform researchers, community organizations, and funding agencies in intervention development and implementation to address built environment barriers.

Social participation of adults aging with long-term physical disabilities: A cross-sectional study investigating the role of transportation mode and urban vs rural living

BackgroundAdults aging with long-term physical disabilities (AAwPDs) experience barriers in the built environment that can hinder their participation in meaningful social roles and activities. However, interventions addressing built environment barriers to participation for AAwPD are limited. ObjectiveThe purpose of this study was to examine how the built environment and other socioenvironmental factors influence the social participation of AAwPD to inform future interventions and service provision. We hypothesized that social participation would be significantly different between AAwPD using private versus public transportation and living in urban versus rural areas. MethodsThis cross-sectional study of 331 Missouri-dwelling AAwPD reports findings on relationships among transportation mode, urban versus rural residence, and ability to participate in social roles and activities using PROMIS measures. A multivariate analysis of covariance (MANCOVA) explored differences in social participation across transportation mode and residential location. Linear regression examined associations among socioenvironmental factors, individual factors, and social participation. ResultsThe MANCOVA demonstrated significant differences in social participation across transportation mode and urban versus rural residential location. Specifically, AAwPD using paratransit and living in urban areas reported significantly higher social participation than rural-dwelling individuals and private transportation users (p < .001). The linear regression revealed that individual factors served a larger role in predicting social participation than built or social environmental factors. ConclusionsOur findings suggest that transportation mode plays a significant role in shaping social participation outcomes for AAwPD. However, compared to built and social environmental factors, individual factors (i.e., physical function, ‘aging-with-disability’ symptoms) may restrict social participation more.

The Role of the Built Environment in the Community Participation of Adults Aging With Long-Term Physical Disabilities: A Scoping Review

The purpose of this scoping review was to characterize the nature and scope of existing literature on the role of built environments in the community participation of adults aging with physical disabilities (AAwPD). A scoping review was selected to identify the volume and types of evidence available, pinpoint knowledge gaps, and clarify key concepts. Twenty-one articles were included for review, all of which were published within the last 20 years and identified components of the built environment for intervention. Results demonstrated the need for investigators to identify common indicators, use a shared lexicon, and improve dissemination of results across disciplines.

Exploring the Perspectives of Adults Aging With Long-Term Physical Disabilities on Physical Activity: A Qualitative Study.

Adults aging with long-term physical disabilities (AAwPD) face personal and environmental barriers to living independently, but little is known about their perspectives on and experiences with physical activity (PA). The purpose of this study was to explore the perspectives of AAwPD on PA. Qualitative semi-structured interviews with AAwPD were conducted virtually via phone or videoconference. A convenience sample of AAwPD aged 45-65 and living with a physical disability for at least 5years was recruited through aging organizations, disability organizations, and social media in St. Louis, Missouri until thematic saturation was reached (n = 20). Participants were asked semi-structured interview questions about their perspectives and experiences with PA following an interview guide developed by disability, aging, and qualitative research experts. Data were analyzed using text analysis in NVivo 12. Codes were developed into themes by the research team and validated using member checking methods. Four themes emerged from the data: barriers and facilitators to engaging in PA, motivations and beliefs regarding PA, benefits of PA, and PA routines and habits. Participants reported a desire to engage in more PA but described barriers such as pain and fatigue symptoms, secondary health conditions, lack of social support, and fear of falling. Accessibility of facilities and equipment (eg, lack of ramps or equipment not at wheelchair height) and transportation barriers (eg, inconvenient schedules or excessive wait times) were specifically described as major environmental barriers. Most participants' reported PA routines did not meet the quantity or intensity levels recommended by current guidelines. These results may help inform healthcare providers, community programs, and future interventions to improve PA levels for AAwPD, an underserved but growing demographic.

INCREASING SOCIAL CARE CAPACITY TO MEET THE NEEDS OF PERSONS AGING WITH DISABILITY

Abstract This national study presents key informant interview data (N=28) collected 2017-2018 identifying capacity building needs in professional skills, organizational operations, service/care models, and public policies to effectively serve older adults with long-term serious mental illness, intellectual/developmental disabilities, physical and sensory disabilities. A multi-university, interdisciplinary team collected data through phone interviews, coded, and analyzed transcripts thematically and using content analysis. Key informants worked in national affinity organizations, state-level organizations, academia, and social care organizations. Findings are broad in scope, highlighting variances in rural/urban areas, state government dispositions, workforce characteristics, social and health care infrastructure, beliefs about disability and chronic conditions, and other factors. Findings will informed the development of a larger survey study aiming to articulate an agenda for building capacity to meet the needs of aging with disability populations.

Exploring the Physical Activity of Adults Aging With Long-Term Physical Disabilities: A Qualitative Study

<h3>Research Objectives</h3> To qualitatively explore the perspectives of adults aging with long-term physical disabilities (AAwPD) on physical activity (PA), including barriers and facilitators, perceived benefits, motivations and beliefs, and current routines and habits. <h3>Design</h3> A cross-sectional qualitative study with semi-structured interviews was conducted. <h3>Setting</h3> Interviews were conducted either via phone or videoconference with community dwelling AAwPD. <h3>Participants</h3> A convenience sample of AAwPD between the ages of 45-65, living with a physical disability for at least five years, and English-speaking was recruited through aging organizations, disability organizations, and social media until thematic saturation was reached (n=20). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Participants were asked a variety of open-ended, semi-structured interview questions inquiring about their perspectives and experiences with engaging in PA. The questions followed an iteratively developed interview guide vetted by disability, aging, and qualitative research experts. Data were analyzed using standard qualitative text analysis and deductive coding in NVivo 12 using an extensive coding scheme based upon our research questions. Codes were then developed into themes by the research team and validated by study participants using member checking methods. <h3>Results</h3> Four primary themes aligned with our research questions and emerged from the data: barriers and facilitators to engaging in PA, motivations and beliefs toward PA, self-reported benefits of PA, and PA routines and habits. Eighteen of twenty participants reported a desire to engage in more PA than they were currently doing. <h3>Conclusions</h3> Despite participants' interest and motivation, engaging in PA is difficult for many AAwPD due to a multitude of barriers such as symptoms and secondary health conditions, accessibility concerns, and fear of falling. Most participants' reported PA routines did not include the quantity or intensity levels needed to achieve meaningful health benefits according to current guidelines. Participants' reported barriers and facilitators, motivations, benefits, and routines related to PA may help inform healthcare providers, community programs, and future interventions to improve PA levels for AAwPD, an underserved but growing demographic. <h3>Author(s) Disclosures</h3> The authors report no conflicts of interest.

Understanding the Attitudinal Environment as Experienced by Adults with Physical Disabilities: A Qualitative Study

<h3>Research Objectives</h3> To identify where adults with physical disabilities experience the attitudinal environment, the continuum of those attitudes, and how they impact emotional and psychological health and well-being. <h3>Design</h3> Qualitative, using data from both in-person and remotely held focus groups and individual interviews. <h3>Setting</h3> Low-income and racially marginalized communities in Flint and Detroit, Michigan. <h3>Participants</h3> 55 adults with moderate to severe long-term physical disabilities. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Themes associated with participants' experiences of the attitudinal environment extracted form focus groups and individual narratives. <h3>Results</h3> Interviews and focus groups lasted approximately two hours. Analyses revealed that participants did not experience societal attitudes as simply positive or negative, and that the contexts in which these attitudes were expressed were not limited to interpersonal interactions. Rather, participants articulated a spectrum of overlapping attitudes ranging from understanding and supportive, to not understanding, to being viewed and treated as less than human. These attitudes were experienced in three overarching contexts: (1) interpersonal interactions, (2) social institutions, structures, and programs that provide or deny needed accommodations, resources, support, and protection, and (3) the built environment. <h3>Conclusions</h3> Understanding how societal attitudes are interpreted, the spectrum of those attitudes, and the contexts in which they are experienced is important because they impact emotional and psychological health and well-being, as well as physical health. Findings can impact how civil rights and health-related policies reflect and influence—and thus reinforce and maintain—the current attitudinal environment, and how policy change can benefit from targeted work to enhance awareness and attitudes about disability and people with disability at the individual, institutional, and systemic levels.Social structures reflect and influence societal attitudes and have material consequences on the lives of adults with physical disabilities. <h3>Author(s) Disclosures</h3> We have no conflicts of interest.

A protocol for Removing Environmental Barriers to Independent Living (REBIL): An adapted evidence-based occupational therapy intervention to increase community participation for individuals aging with long-term physical disabilities.

People aging with long-term physical disabilities (PAwLTPD) are living longer and experiencing the challenges of aging, including the onset of secondary and age-related health conditions. PAwLTPD are at high risk of falls, fall injuries, diminished functional abilities, and compromised participation. However, no available programs support PAwLTPD to participate safely at home and in the community. The proposed study is to examine the feasibility and efficacy of an adapted intervention: Removing Environmental Barriers to Independent Living (REBIL). A single-blinded randomized controlled trial (RCT) will be conducted. Participants who are 45-65 years old; self-report difficulty with ≥2 daily activities; have had a physical disability for ≥5 years; and live within 60 miles of the research lab are eligible. All participants will receive an initial in-home evaluation before randomization. The treatment group will receive REBIL (total five visits), which is tailored. The waitlist control group will be offered the same intervention after 6-month follow-up. Expected outcomes are high acceptability, fidelity, and adherence; low safety risk; improved community participation and daily activities performance; and fewer environmental barriers and fall hazards. Findings will serve as preliminary evidence for occupational therapy community practice. Outcomes will also inform future large, pragmatic trials. ClinicalTrials.gov identifier NCT04589988.

COVID-19: Factors Predicting Depressive Symptoms in People Aging With Long-Term Physical Disabilities.

The mental health impact of the COVID-19 pandemic may be greater than that of the viral infection. This impact is likely greater for disadvantaged groups such as people with long-term physical disabilities (PwLTPD). This cross-sectional study used a multiple linear regression model to examine factors associated with depressive symptoms and to understand their relative importance during the onset of the COVID-19 pandemic. The model explained 58% of the variance in depressive symptoms. Anxiety was the most important predictor, accounting for 8% of variance. Higher levels of anxiety, loneliness, and financial stress; prior diagnosis of depression; and non-Black race predicted a higher level of depressive symptoms in PwLTPD during the onset of the COVID-19 pandemic. Occupational therapy practitioners should strategically acknowledge predictors of depression that cannot be modified and actively address those that can be modified through evidence-based interventions to improve depressive symptoms in PwLTPD.

Ableism and Contours of the Attitudinal Environment as Identified by Adults with Long-Term Physical Disabilities: A Qualitative Study.

Adults with physical disabilities experience a continuum of enabling and disabling attitudes in the environment. This study identified where adults with physical disabilities experience the attitudinal environment, the continuum of those attitudes, and how they impact emotional and psychological health and well-being. Focus groups and interviews were conducted in 2019 and 2020 with adults with physical disabilities in southeastern Michigan in the United States. Participants discussed environmental factors that impact healthy aging. From an initial thematic coding of narratives, the attitudinal environment was identified. Transcripts were recoded and analyzed focusing on societal attitudes. Qualitative analyses revealed that participants did not experience societal attitudes as simply positive or negative, and that the contexts in which these attitudes were expressed were not limited to interpersonal interactions. Rather, these attitudes were also experienced in the built environment and through social institutions and organizations and their programs, systems, and structures that provide or deny needed accommodations, resources, and support. The spectrum of overlapping attitudes that participants articulated ranged from understanding and supportive, to not understanding, to being viewed and treated as less than human. Societal structures reflect and influence societal attitudes and have material consequences on the lives of adults with physical disabilities.

COVID-19 and multiple sclerosis: An updated report of the community-based longitudinal UK MS Register study

COVID-19 is a concern in people with multiple sclerosis (MS), mostly because of their long-term physical disabilities and immunomodulatory disease-modifying therapies (DMTs). In this community-based pro- spective longitudinal study, we have been monitoring a cohort of people with MS via the web-based platform of the UK MS Register since the start of the COVID-19 outbreak. We report our findings from 17/03/2020 to 15/01/2021.Out of 7344 participants, 883 (12%) have reported a self-diagnosis of COVID-19 of whom 211 had a confirmed clinical or laboratory-based (n=114) diagnosis. No individual DMT increased the likelihood of contracting COVID-19 (with any of the diagnoses as the outcome). Gender (male: female, adjusted OR: 95% CI [0.94: 0.68–1.3]), web-based Expanded Disability Status Scale score (webEDSS; one-point increase, 0.92: 0.84–1.01), and MS duration (one-year increase, 1: 0.98–1.02) were not associated with contracting COVID-19. Younger age (one-year decrease, 1.04: 1.03–1.06), ethnicities other than white (1.95: 1.13–3.34), and relapsing-remitting MS (versus progressive, 1.72: 2.56–1.16) increased the likelihood of contracting COVID-19. Within a median (interquartile range) of 26 (0–72) days follow-up of participants with COVID-19 (n=532), 69% reported full recovery. A higher webEDSS (one-point increase, 0.84: 0.74–0.96) lowered the likelihood of full recovery. Overall, MS-specific factors do not predispose people with MS to contracting COVID-19, but physical disability can delay recovery.afagh.garjani@nottingham.ac.uk

Automated Intracranial Hematoma Classification in Traumatic Brain Injury (TBI) Patients Using Meta-Heuristic Optimization Techniques

Traumatic Brain Injury (TBI) is a devastating and life-threatening medical condition that can result in long-term physical and mental disabilities and even death. Early and accurate detection of Intracranial Hemorrhage (ICH) in TBI is crucial for analysis and treatment, as the condition can deteriorate significantly with time. Hence, a rapid, reliable, and cost-effective computer-aided approach that can initially capture the hematoma features is highly relevant for real-time clinical diagnostics. In this study, the Gray Level Occurrence Matrix (GLCM), the Gray Level Run Length Matrix (GLRLM), and Hu moments are used to generate the texture features. The best set of discriminating features are obtained using various meta-heuristic algorithms, and these optimal features are subjected to different classifiers. The synthetic samples are generated using ADASYN to compensate for the data imbalance. The proposed CAD system attained 95.74% accuracy, 96.93% sensitivity, and 94.67% specificity using statistical and GLRLM features along with KNN classifier. Thus, the developed automated system can enhance the accuracy of hematoma detection, aid clinicians in the fast interpretation of CT images, and streamline triage workflow.

A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination personnel

Introduction &amp; Importance: Effective, patient-centered care coordination has been shown to improve outcomes for children with special healthcare needs (CSHCN), who often have complex, long-term involvement with multiple service providers. Traumatic brain injury (TBI) can result in long-term physical, intellectual, social, and emotional disabilities that persist long after acute treatment. Yet, even though it is a chronic condition, TBI remains an area with scarce standardization and research surrounding the complex, long-term care coordination need in this population. The purpose of this scoping review is to summarize current research on outcomes in CSHCN after implementation of care coordinators, whether individual or teams, to inform future research for youth with TBI. Methods: OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination and CSHCN. Results: 31 articles met inclusion criteria. Outcomes for children and families were grouped into 5 major categories: healthcare utilization, cost of care, disease status, parent and child quality of life, and healthcare satisfaction and perception of care. Discussion: Implementation of care coordinators, whether in the form of individuals, dyads, or teams, resulted in overall positive outcomes for CSHCN and their families across all 5 major outcome domains. Future research should be focused on the efficacy of care coordinators differing in profession, qualifications, and educational attainment specifically for the unique needs of children with TBI. Additionally, the application of care coordination within medical homes should be further investigated to increase proactive, preventative care of children with TBI and further reduce reactive, need-based treatment only.

Fear, Isolation, and Invisibility During the COVID-19 Pandemic: A Qualitative Study of Adults With Physical Disabilities

Research ObjectivesTo examine the initial impact of the COVID-19 pandemic on adults with severe physical disabilities from low-income and racially marginalized communities.DesignQualitative, observational using individual interviews conducted at a distance.SettingLow-income, racially marginalized communities of Flint and Detroit, Michigan.Participants15 adults with severe, long-term physical disabilities.InterventionsNot applicable.Main Outcome MeasuresThemes associated with COVID related responses extracted from individual narratives.ResultsLength of interviews averaged one hour and forty minutes. Six themes emerged from the data. Overarching factors were fear, feelings of isolation, and a sense of being invisibility. These factors were experienced as a result of barriers to health and healthcare, home care assistance, and access to resources.ConclusionsFindings expand existing knowledge and offer new insights into how the pandemic impacted physical and psychological health of adults with long-term physical disabilities and made visible the risks that they must contend with as a result of inadequate or insufficient accommodations. They help elucidate how race/ethnicity and socioeconomic status can differentially impact their lives and further marginalize populations that are “always already” vulnerable. This knowledge can expand awareness and appreciation of how social, economic, and political systems are structured and integrated into future clinical guidelines and emergency response policies.Author(s) DisclosuresNothing to disclose.

Study of the Incidence of Some Chronic Diseases Among patients with Long-term Physical Disabilities

Background: People living in old age with disabilities acquired in early adulthood or because of a congenital anomaly represent a growing population with unique medical needs. This study aims to investigate the incidences of chronic diseases and the prevalence of chronic polymorbidity among adults with physical disabilities, who are accommodated in the largest social home on the Balkan Peninsula. Methods: In this descriptive survey, 179 people with physical disabilities were studied during 2017- 2018. A structured questionnaire was used to obtain information on socio-demographic characteristics, personal lifestyle and self-reported diagnosis of the presence of chronic diseases. In addition to the above, second research was conducted on the available medical documentation for the health status of each person, which helped to verify the information about the incidence and prevalence of chronic diseases among adults with physical disabilities. Results: Most of the adults with physical disabilities have at least more than two chronic conditions (69.27 %). Arterial hypertension is the commonest chronic illness among them (47. 48 %). The study reported a raised incidence of chronic diseases of the digestive system and chronic diseases of the urinary system, as well as increasing prevalence of diabetes mellitus type II, chronic diseases of the pulmonary system and degenerative joints diseases correlated with the age of persons. Conclusion: The study showed an increased frequency of chronic diseases among adults with physical disabilities and a significant number of persons who have multiple chronic conditions, which determines the need for frequent and long-term health care.

A Multidisciplinary Journey towards Bone Tissue Engineering.

Millions of patients suffer yearly from bone fractures and disorders such as osteoporosis or cancer, which constitute the most common causes of severe long-term pain and physical disabilities. The intrinsic capacity of bone to repair the damaged bone allows normal healing of most small bone injuries. However, larger bone defects or more complex diseases require additional stimulation to fully heal. In this context, the traditional routes to address bone disorders present several associated drawbacks concerning their efficacy and cost-effectiveness. Thus, alternative therapies become necessary to overcome these limitations. In recent decades, bone tissue engineering has emerged as a promising interdisciplinary strategy to mimic environments specifically designed to facilitate bone tissue regeneration. Approaches developed to date aim at three essential factors: osteoconductive scaffolds, osteoinduction through growth factors, and cells with osteogenic capability. This review addresses the biological basis of bone and its remodeling process, providing an overview of the bone tissue engineering strategies developed to date and describing the mechanisms that underlie cell–biomaterial interactions.

Obligation of Religious Practices for the Deaf

Persons with disabilities are those who have long-term physical, mental or intelectual disabilities that may hinder them to give full and effective participation within a society. The hearing impaired are one of them with a specific incapacity of hearing. They refer to a community with hearing loss of above 90 dB. At this level, they would need hearing aids or a mastery in sign language. Religious life is important to every living individual. It is a powerful catalyst for human beings to grow spiritually, physically and intellectually, and acts as a control force in their thoughts and actions. An individual who possesses high religious knowledge will adapt an organized and committed routine in their religious practices, thus resulting in strong work ethic, high family responsibilities and great quality of life. The question here is, do those categorized as hearing impaired have any obligation or duty to perform religious practices? This paper will analyze this matter based on the research done.

Rehabilitation, a necessity in hospitalized and discharged people infected with COVID-19: a narrative review

Novel coronavirus spread all around the world furiously and COVID-19 epidemic has become a global crisis. Limitation in social interactions and rules to avoid close in person contacts was mandatory as the first line facing the virus in many countries. For infected people, medical services are managing clients using existing drugs; In many countries, trials are being conducted to detect vaccines and effective antiviral medications to control the disease. In addition to the adverse effects of the acute disease itself, prolong hospitalization was associated with an array of consequences that may engage survivors with serious long-term cardiorespiratory, physical and mental disabilities. Rehabilitation needs to be considered as a part of the in-patient and out-patient care for people infected by COVID-19 and should begin as soon as possible since along with the pharmacological interventions, it may minimize the hospitalization period, decrease the cardiopulmonary, musculoskeletal and mental consequences of infection as well as prolong bed rest side effects. This fact implies long-term planning and commitments to provide extensive rehabilitation services for a large number of individuals who were infected by COVID-19 or were in close contact with the clients. This review summarizes current finding about rehabilitation of people suffering from COVID-19 infection and provides an evidence based platform for discussing rehabilitation strategies.